Guest Waiver Form

  • NameDate of Birth 
  • Waiver

    I/We the undersigned, realize that there my be medical risks associated with physical exercise, the use of this facility or use of equipment within the facility. I/We also recognize that Harleysville Pool cannot evaluate my/our physical abilities and medical limitations as they pertain to participation in programs, to the use of the facilities, or use of equipment within the facility; I/We therefore assume all responsibility for having a thorough medical examination performed, by a medial practitioner of my/our own choice, before participating in any programs and prior to using the facilities or equipment with the facilities. I/We also assume all responsibility for abiding by the recommendations of said medical practitioner, including but not limited to, as they pertain to limitations on exercise, participation in Harleysville Pool programs and use of the Harleysville Pool facilities or equipment with the Harleysville Pool facilities.

    Furthermore, in consideration of my participation in the activities of the Harleysville Pool, I/we do hereby agree to hold free from any and all liability the Harleysville Pool and its respective officers, employees and members, including but not limited to its or their own negligence, and do hereby for my self, my heirs, executors and administrators , waive release and forever discharge any and all rights and claims for damages which I/we may have or which may hereafter accrue to me arising out of or connected with my participation in any of the activities of the Harleysville Pool, use of its facilities; provided.

    I/We the undersigned have read, understand and agree to the above.